Facility Evaluation Report

On 11/16/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual required inspection. LPA arrived, introduced self, and stated purpose of visit. LPA allowed entrance by Direct Care staff. House Manager contacted by telephone, and arrived a short time later to conduct facility inspection.

Currently, there are four (4) residents in placement, all residents were present at time of inspection. LPA observed facility to be clean, odor free, and maintained at a comfortable temperature. Facility tour conducted, all resident bedrooms observed to be private bedrooms. All bedrooms, observed to have required furnishings available. Resident bathrooms toured, LPA observed shower chairs, grab bars, and non-skid mats. Water temperature measured at 115 degrees F. Kitchen toured, facility observed to have a 2-day supply of perishable and a 7-day supply of non-perishable available. Kitchen knives observed to be locked and secured in hall closet. Medications observed to be locked and secured in medication cart. LPA observed medication bubble packs to have original labels and to be administered as prescribed

Smoke detector and carbon monoxide detector observed operational at time of inspection. Fire extinguisher has a service date of 9/11/2024 . Last fire drill conducted on 11/09/24 according to facility records.

Outside toured. All exits open free of obstruction. No hazards observed

No deficiencies observed. Exit Interview conducted with House Manager and a copy of report provided for facility records.